Application of QSEN competencies in a practice setting: The case of Cincinnati Children s Hospital Medical Center

Transcription

1 Application of QSEN competencies in a practice setting: The case of Cincinnati Children s Hospital Medical Center Heather L. Tubbs Cooley, PhD, RN Assistant Professor & Nurse Scientist CCHMC Quality Scholar

2 Objectives for today s talk Describe quality improvement, safety, and evidence-based practice (EBP) educational offerings for nurses at Cincinnati Children s Highlight exemplar nurse-led projects that address QSEN competencies Discuss challenges and opportunities associated with implementing QSEN competencies in a practice setting

3 CCHMC s improvement journey RWJF Pursuing Perfection grantee, 2002 Cystic fibrosis as a test case for improvement The James M. Anderson Center for Health Systems Excellence, est Quality improvement Research Rapid translation of evidence into clinical care Training the next generation of health care improvers and improvement science researchers Our motto: We will be the best at getting better.

4 CCHMC quality, safety, and EBP programming Rapid Cycle Improvement Collaborative Intermediate Improvement Science Seminar Advanced Improvement Methods Quality Scholars Program Point-of-Care Scholars Program Web-based modules

5 QI methodology Model for Improvement and Deming s System of Profound Knowledge Specific aims and well-developed measures Use of theory to guide interventions & testing Data plotted on run/control charts to see trends over time and effects of interventions Iterative Plan-Do-Study-Act cycles Planning for sustain and spread

6 Rapid Cycle Improvement Collaborative Improvement in a highly-focused project in 120 days For team leaders and their respective teams Goals: Develop team leaders Build team member capability in Model for Improvement

7 03/21/11 03/22/11 03/23/11 03/24/11 03/25/11 03/26/11 03/27/11 03/28/11 03/29/11 03/30/11 03/31/11 04/01/11 04/02/11 04/03/11 04/04/11 04/05/11 04/06/11 04/07/11 04/08/11 04/09/11 04/10/11 04/11/11 04/12/11 04/13/11 04/14/11 04/15/11 04/16/11 04/17/11 04/18/11 04/19/11 04/20/11 04/21/11 04/22/11 04/23/11 04/24/11 04/25/11 04/26/11 04/27/11 04/28/11 04/29/11 04/30/11 05/01/11 05/02/11 05/03/11 05/04/11 05/05/11 05/06/11 05/07/11 05/08/11 05/09/11 05/10/11 05/11/11 05/12/11 05/13/11 05/14/11 05/15/11 05/16/11 05/17/11 05/18/11 05/19/11 05/20/11 05/21/11 05/22/11 05/23/11 05/24/11 05/25/11 05/26/11 05/27/11 05/28/11 05/29/11 05/30/11 05/31/11 06/01/11 06/02/11 06/03/11 06/04/11 06/05/11 06/06/11 06/07/11 06/08/11 06/09/11 06/10/11 06/11/11 06/12/11 06/13/11 06/14/11 Decibel (db(a)) level of noise Visual cues Various visual cues Electrical outage reset device and lost data Staff survey Informational board trash cans into hallway? Huddle reminder Rapid Cycle Improvement Collaborative (RCIC) 70 Noise Reduction on the TCC (beginning 3/21/11) Maximum Reading of the Hourly Averages Proper lead placement reminders and visual aide screensaver to each computer change pyxis stock times? "Do not enter" sign on pt. door 40 Nightly Dates Max reading of the Hourly Average Noise level Median of maximum reading of the hourly averages of noise levels Goals Linear (Goals)

8 Intermediate Improvement Science Seminar A transformational QI & leadership development course for physician, nurse, allied health professional, admin. and support staff leaders. Candidates must be nominated by executive leaders. Goals: Develop intermediate level of QI knowledge to do improvement, lead improvement, and get results in six months

9 4/7/2011 (n=27) 4/14/2011 (n=55) 4/21/2011 (n=21) 4/28/2011 (n=39) 5/5/2011 (n=47) 5/12/2011 (n=37) 5/19/2011 (n=50) 5/26/2011 (n=00) 6/2/2011 (n=00) 6/9/2011 (n=00) 6/16/2011 (n=00) 6/23/2011 (n=00) 6/30/2011 (n=00) 7/7/2011 (n=00) 7/14/2011 (n=31) 7/21/2011 (n=33) 7/28/2011 (n=32) 8/4/2011 (n=22) 8/11/2011 (n=35) 8/18/2011 (n=40) 8/25/2011 (n=46) 9/1/2011 (n=43) 9/8/2011 (n=22) 9/15/2011 (n=12) 9/22/2011 (n=25) 9/29/2011 (n=56) 10/6/2011 (n=10) 10/13/2011 (n=06) 10/20/2011 (n=25) 10/27/2011 (n=09) 11/3/2011 (n=19) 11/10/2011 (n=16) 11/17/2011 (n=15) 11/24/2011 (n=00) 12/1/2011 (n=12) 12/8/2011 (n=31) 12/15/2011 (n=25) 12/22/2011 (n=33) 12/29/2011 (n=06) 1/5/2012 (n=15) 1/12/2012 (n=28) 1/19/2012 (n=29) 1/26/2012 (n=34) 2/2/2012 (n=21) 2/9/2012 (n=29) 2/16/2012 (n=30) 2/23/2012 (n=43) 3/1/2012 (n=48) 3/8/2012 (n=39) 3/15/2012 (n=35) 3/22/2012 (n=48) 3/29/2012 (n=59) 4/5/2012 (n=32) 4/12/2012 (n=35) 4/19/2012 (n=47) 4/26/2012 (n=39) 5/3/2012 (n=38) 5/10/2012 (n=24) Percentage of Nurses in Cardiology Rounds 1.00 Percentage of Nurse Participation in Rounds (Weekly Data) April June 2012 SAFE Tool on Worklist 3/17/12 Flow of Rounds/Script 4/2-4/15/ HUC Page 3/19-3/20/ Bedside tables and chairs 2/6/12 Only bedside RN 2/22/ Flashing of lights on and off 12/7/11 Week of Thanksgiving Laminated SAFE Tool at workstations 3/9/12 Building Reliabilty Posting Run Chart Follow-up with staff 3/1/12 Desired Direction Weekly Data Daily Percentage Median Goal (0.75)

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12 01/01 01/22 02/24 03/03 03/07 03/14 03/18 04/06 04/11 05/09 05/12 05/13 05/15 05/26 05/28 06/03 06/04 06/09 06/22 06/23 07/20 07/21 08/09 08/17 09/10 09/11 09/27 09/28 10/02 10/03 10/24 11/01 12/01 12/02 12/05 12/16 12/22 12/31 01/08 01/14 02/02 02/06 02/17 02/18 03/04 03/26 04/16 05/01 05/03 05/19 05/30 06/29 07/02 07/23 08/01 08/18 09/19 09/29 10/07 10/14 10/24 10/25 11/12 11/21 12/02 01/12 Days Since Previous Event A5N Days-Between 5 Rights Related Medication Administration Errors January 1, 2010 thru January 12, Project Goal: Increase average days between from 10.8 days to days RESULT = 14.5 Days Between /19/11 "Light" testing initiated 2-10/28/11 0edication Administration Process Review Tool 3-11/4/11 System Issue Communication Log Sheet 4-11/28/11 Daily Pt. Room Computer Reboot 5-11/30/11 Medication Administration Bundle Days Since Previous Event Average Days Between Events Control Limits

13 Point-of Care Scholars Program 12-month EBP program for nursing and allied health employees 2 cohorts/year, per cohort 8 hours per week dedicated to program Desired outcomes Scholar gains EBP skill set and enriches home unit by assisting others Critical appraisal of literature, resulting in: Practice/policy change when evidence is supportive (& QI skills to support implementation) Small research study when more evidence is needed Best Evidence Statement (BESt) and/or publication of findings

14 Additional supporting structures Unit-based councils Hospital-level councils for RNs and APNs Grand Rounds Consultations with nurse scientists Center for Clinical and Translational Science (NIH CTSA)

15 Challenges Limited RN knowledge/skills/attitudes regarding QSEN competencies View of bedside RN as subject matter expert but not a team leader Scarce RN time and competing priorities

16 Opportunities Implementation/continuation of programming to developing and reinforce QSEN competencies Nursing orientation/residencies Dissemination of RCIC/I2S2/POCS knowledge at unit level

17 Thank you.

18 Project acknowledgments TCC noise reduction: Tammy Alexander, MSN, RN, CPN Nurse participation in rounds: Julie Kleiman, BSN, RN D/C with multi-dose meds: Karen Tucker, MSN, RN PICU rejected lab specimens: Erik Martin, MSN, RN Medication administration: Laura Flesch, MSN, RN, CRNP